The common question, “Can I get Medicare through my spouse,” pops up daily. As people near the age of 65, one of the things they look forward to is Medicare benefits. Those that didn’t pay into social security have a concern of eligibility.
Luckily, Medicare isn’t just for people that work most of their lives and then retire.
In all actuality, any U.S. citizen or legal resident for at least five years are eligible if they meet these conditions:
- Be 65 years of age or older
- For those individuals under the age of 65, with a qualifying disability
- Currently, have End-Stage Renal Disease
Then comes the big question. Can my non-working spouse qualify for Medicare?
Get Medicare Through a Working Spouse
With Traditional Medicare benefits providing excellent healthcare coverage, many look forward to the day they become eligible for government-funded health insurance.
Upon turning sixty-five years old, you’re automatically eligible to enroll in Part A, your hospital benefits. With Part A, there is no monthly premium charge, so you’ll want to join as soon as you become eligible.
Your GEP begins the three months leading up to your 65th birthday. It then continues through the month of and three months after turning sixty-five.
Failing to enroll in Part B during the General Enrollment Period puts you at risk for the Part B Penalty.
How to Apply for Medicare Through Spouse
To apply for Medicare through a spouse, go online, and select to apply for retirement benefits through SSA. Then, accept the terms of service to start.
You’ll need Personal Information to apply, such as name, ss number, birthday, W-2 information, and more. If you can’t complete the application in one sitting, save the form, write down your re-entry number, and finish another time.
The application includes questions about your work and benefits. Be sure to review your application before hitting submit to SSA. If at any time you have a question, contact Social Security.
Medicare for Non-Working Spouse Eligibility
For non-working spouses wanting to enroll, you’ll want first to make sure the working spouse meets the conditions for Medicare eligibility. Once you determine eligibility, you too may get premium-free Part A benefits.
Eligibility for Medicare through your spouse applies to you if you meet the following criteria:
- Your spouse must be at least sixty-two years of age and qualify for social security benefits.
- If you have been married for at least five years, and your spouse is eligible for social security benefits.
- Have End-Stage Renal Disease and currently get disability benefits.
- If you currently collect disability benefits from certain railroad retirement benefits or social security for the last 24 months.
- have amyotrophic lateral sclerosis (ALS)
- don’t qualify for disability; you must wait until the age of sixty-five to become eligible.
Also, divorced and widowed people may apply for Medicare from a prior spouse.
If married to your former spouse for at least ten years and that spouse met the conditions for social security benefits, you must currently be single to qualify.
If you’re widowed and were married to your former spouse for at least nine months, to qualify yourself, you must currently be single.
How Getting Married Can Affect Medicare
Medicare is individual coverage; although, you may use spouse eligibility to enroll in benefits. Even if coverage doesn’t start at the same time, recipients can use spouse work credits for SSI eligibility.
There is no family Medicare plan; so, expect to have a separate enrollment for extra coverage.
Getting married won’t make you ineligible for Medicare.
Will Getting Married Affect My Medicare Part-D Extra Help
If the combination of both earnings increases you above the income eligibility amount, you’ll no longer qualify for Extra Help. However, if both of your benefits combine and remain in the “low-income” status, you’ll both get extra help.
You may only lose a portion of benefits, or you may gain more; the only way to determine a change is to apply both incomes to eligibility standards.
Medicare Part B Through Spouse Coverage
For Part B coverage, the spouse must wait until age sixty-five for eligibility. They can still be eligible regardless of work history as long as the working or retired spouse has at least ten years of work history.
Regardless of which spouse is applying, eligibility starts at age sixty-five unless the non-working spouse is older than the working spouse, which must be at least sixty-two years of age.
If the non-working spouse currently carries employee health benefits offered by the working spouse’s employer, they may want to only enroll in premium-free Part A.
Part B can be added later on, as long as the spouse’s employer insurance is credible. Enrollment can happen at any time without penalty.
Special Exceptions for Non-working Spouse’s
If you worry about losing group health insurance from your spouse’s employer due to Medicare eligibility and you, yourself don’t qualify; there’s hope.
You automatically qualify for the Special Election Period under the Affordable Care Act. You can then go onto healthcare.gov to sign up for your own individual health insurance plan on the Healthcare Marketplace.
Also, if the working spouse contributes to a health savings account (HSA), the IRS prohibits future contributions once enrolled in Medicare. However, this does not apply to the non-working spouse.
No matter if you’re the working or non-working spouse, you’ll each have your own Medicare card and number. Also, you must pay your separate Part B monthly premiums.
A Supplement Plan helps cover items like deductibles, copayments, coinsurance, and other out of pocket costs. With some of the Supplement Plans that may offer some savings on the monthly premium costs through a “Spousal Discount.”
Also, there are Medicare Advantage Plans which take over for Parts A and Part B Medicare benefits.
Premiums tend to be cheaper, and some plans offer Part D. The cons like in-network doctors and facilities, prior authorizations, and no nationwide coverage can outweigh any of the plan benefits.
Non-working spouses have extra benefits of signing up for both the Advantage Plans or Supplement Plans.
You can compare Advantage Plans and Medigap Plans to see which plan best suits your needs.
Get Medicare Part D Through Your Spouse
Neither Part A or Part B offers Part D benefits. By purchasing a Part D, you have the interest of prescription drug coverage.
But just as Part B has a late enrollment penalty, there is also a Part D penalty.
To avoid an extra fee to your Part D monthly premium, you’ll want to enroll asap during your Open Enrollment Period.
With the Part D late enrollment penalty, any continuous period of 63 days or more after your Initial Enrollment Period has expired will result in an extra charge. Depending on how long you went without Part D will depend on the additional cost in premium.
If you have any questions regarding getting Medicare through your spouse, enrollment periods, or additional Medicare policies, we can help. We here at Medicare FAQ have insurance agents that can help answer questions.
Call us at the number above or fill out our online rate form and compare rates today!
Health insurance is confusing enough; let us help take some of the burdens off your shoulders. We do the “heavy lifting” and guide you through Medicare.
After all, first comes love, then comes marriage, then comes the added perk of reaping the benefits of Medicare once your spouse has become eligible!